IMPROVING SURVIVAL IN PATIENTS WITH MITRAL VALVE REGURGITATION

The correlation between volume of mitral valve repairs performed each year and the success rate of those repairs has been demonstrated repeatedly in published studies. That’s important since very few centers in the United States come anywhere near the CIC_Feb_Mvalvevolume of mitral valve repairs performed by cardiac surgeons at the University of Michigan Frankel Cardiovascular Center.

“Mitral valve regurgitation is a disease you can often cure. If a repair can be performed, the life expectancy of the patient can be restored to what it would have been in the absence of regurgitation,” explained Steven F. Bolling, MD, professor of cardiac surgery and director of the Multidisciplinary Mitral Valve Clinic at the Frankel Cardiovascular Center.

In hospitals that are not equipped to offer repair, the default treatment is often a prosthetic valve, whether mechanical or created from animal tissue. For patients who otherwise have an extended expected survival, the data are clear.

GREATER CHANCES FOR SUCCESS

“Bioprosthetic valves fail over time. In eight to 10 years, the patient will need a replacement, which introduces additional costs as well as risks. In good candidates, repair will eliminate mitral valve regurgitation as a cause of cardiovascular dysfunction,” said Dr. Bolling, who is one of the preeminent experts in this field. Indeed, Dr. Bolling is one of only three cardiac surgeons in the United States who perform more than 100 cases of mitral valve repair annually.

It has been estimated that 175 mitral valve repairs are required before cardiac surgeons achieve an optimal level of skill, yet few cardiac surgeons perform this many cases in their lifetime. Indeed, most do only a few cases per year. At the Frankel Cardiovascular Center, where Dr. Bolling is one of several cardiac surgeons performing a high volume of mitral valve repairs, the success rate now exceeds 99%. By contrast, surveys show that surgeons who do not do a high rate of these procedures have lower success rates (Ann Thorac Surg 2010;90[6]:1904-1911).

INDIVIDUALIZED CARE

While early referral is key for best outcomes, not every patient with mitral valve regurgitation is a candidate for repair. In some, a prosthesis may be the best option, particularly for those with a limited life span who have significant deterioration of the mitral valve, rheumatic disease or possibly some ischemic-related causes of mitral valve regurgitation. In others, newer options can be considered. Many of these innovations are being developed or tested at the Frankel Cardiovascular Center through clinical trials.

“We are not just specialists in repair. Our strength is that we are skilled with the full spectrum of options so we can individualize therapy,” Dr. Bolling said.

CIC_Feb_Bolling

Steven F. Bolling, MD

“ The data suggest that volume is perhaps the single most important factor for determining success, and we manage thousands of patients with mitral valve disease.”
—Steven F. Bolling, MD

“ Physicians who detect or suspect mitral valve regurgitation should send their patients for evaluation before there is significant deterioration. In addition, repairs will improve quality of life in a symptomatic patient, so there is no value in waiting.”
—Steven F. Bolling, MD

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